People’s eczema can deteriorate when the weather turns colder. Kathy Oxtoby looks at the advice and support pharmacists can offer patients to help manage their condition during winter...

Eczema is a common skin condition that can affect anyone of any age but presents most frequently in childhood. One in five children and one in 12 adults has eczema, according to the National Eczema Society.¹

This distressing condition can deteriorate when the weather turns colder. Community pharmacists should be alert for customers whose skin condition may have deteriorated, and be ready to advise on how best to deal with eczema flare-ups during the winter months.

“Community pharmacy has an important role to play, not only in advising patients on how to manage their condition, but in helping them understand what’s going on with their skin,” says Ade Williams, lead pharmacist at Bedminster Pharmacy, Bristol.

Eczema, also sometimes referred to as dermatitis, describes a range of skin conditions resulting in dry, inflamed and often itchy skin, says Dr Rabi Nambi of the British Association of Dermatologists. He explains: “There are different types of eczema, with different causes, but often when people speak about eczema, they are referring to atopic eczema.

“Like other atopic conditions such as asthma or hay fever, atopic eczema is linked to how the body’s immune system reacts to allergy. In people with atopic conditions, the immune system reacts far more actively to allergy.”

The main symptom is itchiness, “which can be severe enough to interfere with sleep, causing tiredness and irritability”, says Dr Nambi. “Typically, atopic eczema goes through phases of being severe, less severe, and then gets worse again.”

Different factors that can trigger a flare-up of atopic eczema include heat, dust, wool, pets, irritants such as soap and detergents, dry skin, being unwell, and stress, says Dr Nambi.

For many people, winter weather can also play havoc with their eczema. “Cold winter air strips the skin of vital moisture and can make dry skin problems worse. Similarly, central heating dries out the air in buildings, increasing the rate at which the skin loses moisture. On top of this, common winter fabrics, such as wool, can trigger eczema flares or contribute to the urge to scratch your skin,” says Dr Nambi.

Another reason for winter flare-ups is that “some of our normal skincare regimens are compromised - our skin is covered up, and not on show as in the summer, so we tend to ignore it and forget to moisturise. But we’re also ignoring the damage that is happening to our skin,” says Mr Williams.

Treating eczema

“Treatment depends on the severity of the condition and should be done under the guidance of a doctor who can assess the patient’s skin first,” says Dr Nambi. “Typically, the first approach will be complete emollient therapy and the use of a topical steroid.”

If eczema is weeping, crusted, or there are pustules, with fever, there may be infection, and NICE guidance recommends antibiotic treatment should be prescribed ². While there is no cure for eczema, there are ways to manage it.

“Complete emollient therapy is the mainstay of treatment for all patients with eczema as the most important part of their treatment - this means regular application of a moisturiser, especially when they are outside during a cold day,” says Dr Nambi.

When supporting people with eczema, pharmacists should take an individualised approach to their care, including recognising that different skin tones may have different sensitivities. “We need to understand the diversity of presentations in our communities and offer guidance to people that relates to their own unique skin colours and tones,” says Mr Williams.

This winter, with the current cost of living crisis, he adds that it is important to remember the financial pressures people are facing regarding the cost of eczema treatments. “A treatment plan that includes emollients, and a steroid cream could cost up to £40. So, it’s worth explaining to people that there are great value pre-payment options,” he says.

Patients also need support in self-managing the dry skin associated with eczema, and they need to manage inflammation flare-ups quickly when they happen, says Andrew Proctor, chief executive of the National Eczema Society.

“Many patients and care-givers need prescribers and pharmacists to take the time to explain how they should use topical corticosteroids safely and effectively if these are needed and listen to and address patient concerns about using steroids," he says.

Preventing flare-ups

People can take active steps to prevent a flare-up by making sure to moisturise their skin more frequently during winter months, for instance by carrying an emollient moisturiser with them when outside, and by applying it immediately after a shower or bath, advises Dr Nambi.

Advice from the National Eczema Society to help people with eczema navigate the transition into the colder months includes keeping their rooms at home at a regular temperature - ideally 18°C - and wearing thin layers that they can slowly build up or remove as they acclimatise to their surroundings. Placing a bowl of water near radiators can help to offset this drying effect and minimise the impact on the skin.³

Rooms should be ventilated daily to prevent house dust mites and mould, which can trigger an eczema flare-up.³Switching to a different emollient or a humectant cream can help to combat the drying effects of harsher weather conditions, the charity says.

People with eczema should have enough topical steroids so that they can act immediately on a flare-up in winter. They may also need to reapply their emollient more frequently at this time of year, should ensure they have a plentiful supply.³

Particular attention should be paid to sensitive areas of skin that are vulnerable to exposure such as the face and hands when heading outside, the charity advises.³ Hats, scarves and gloves, if they are made of rough, scratchy material, will irritate skin that is already ‘on edge’.

People with eczema are advised by the National Eczema Society to choose soft fabrics that are seam free, and to ensure that items that are directly in contact with the skin are as close to 100 per cent cotton as possible.³

As colds and flu can exacerbate eczema, pharmacists can advise patients to take extra precautions with their general health, as well as their skin, including eating a healthy diet and maintaining good hand.³

Studies from 2016 suggest that vitamin D supplements can significantly improve eczema or atopic dermatitis.⁴ Less sunshine during the winter months makes it more difficult for the body to make vitamin D, so Mr Williams recommends patients take supplements to help improve symptoms.

Whatever the season, when helping patients manage eczema flare-ups, Mr Williams says it is important to recognise the impact it can have on their mental health. “Eczema is a highly emotive condition, so make sure you take a personalised and empathetic approach to supporting these patients.”

Resources

British Association of Dermatologists’ Patient Information Leaflets: http://www.bad.org.uk/for-the-public/patient-information-leaflets

National Eczema Society: www.eczema.org The charity also has a nurse supported Eczema Helpline service.

References

1. National Eczema Society (2022) What is eczema? https://eczema.org/information-and-advice/
2. NICE (2022) Eczema - atopic. https://cks.nice.org.uk/topics/eczema-atopic/
3. National Eczema Society (2022) Cold weather and eczema. https://eczema.org/information-and-advice/triggers-for-eczema/weather-and-eczema
4. Kim G, Bae JH. (2016) Vitamin D and atopic dermatitis: A systematic review and meta-analysis. Nutrition. 2016 Sep;32(9):913-20. https://www.sciencedirect.com/science/article/abs/pii/S0899900716000770?via%3Dihub